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Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes

Register-Mihalik, Johna K. PhD, LAT, ATC*,†; Valovich McLeod, Tamara C. PhD, ATC, FNATA; Linnan, Laura A. ScD§; Guskiewicz, Kevin M. PhD, ATC, FNATA*,†; Marshall, Stephen W. PhD†,¶

Clinical Journal of Sport Medicine: May 2017 - Volume 27 - Issue 3 - p 321–324
doi: 10.1097/JSM.0000000000000349
Brief Report

Objective: Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior.

Design: Cross-sectional survey.

Setting: Classroom.

Participants: A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey.

Independent Variables: Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career.

Main Outcome Measures: The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude.

Results: A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333).

Conclusions: Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.

*Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

Athletic Training Programs and School of Osteopathic Medicine, A.T. Still University, Mesa, Arizona;

Departments of §Health Behavior; and

Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Corresponding Author: Johna K. Register-Mihalik, PhD, LAT, ATC, Matthew Gfeller Sport-Related TBI Research Center, 2207 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599-8700 (

Funded in part by a NFL Charities Medical Research Grant. J.R.M. and S.W.M. are partially supported by an ICRC award (R49/CE002479) from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

The authors report no conflicts of interest.

Received August 17, 2015

Accepted April 13, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.